| NPI | 1588058697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC 12402) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 251S00000X | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2015-03-26 |