| NPI | 1619268935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC35453) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA MFC35453) |
| 101YM0800X Counselor, Mental Health (Licence: CA MFC35453) | |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2011-04-20 |