NPI | 1639210826 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 101Y00000X Counselor |
101YM0800X Counselor, Mental Health | |
106H00000X Marriage & Family Therapist | |
106H00000X Marriage & Family Therapist (Licence: CA 54716) | |
Enumeration Date | 2007-02-09 |
Last Update Date | 2011-04-15 |