| NPI | 1598271298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 139310) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 13737) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2023-12-05 |