| NPI | 1639579675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 76881) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 94020370) |
| 101YM0800X Counselor, Mental Health (Licence: CA 94020370) | |
| 103TS0200X Psychologist, School (Licence: CA 101067938) | |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2014-08-27 |