| NPI | 1548567589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 061333) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 52049) |
| 106H00000X Marriage & Family Therapist (Licence: CA 81042) | |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2025-02-10 |