| NPI | 1619359445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT137330) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| 106H00000X Marriage & Family Therapist (Licence: CA AMFT108563) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2024-04-08 |