| NPI | 1548775125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 123996) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 123996) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA B001041018) | |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2023-06-07 |