| NPI | 1649604547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC 51586) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA LPC 167) |
| 101YM0800X Counselor, Mental Health (Licence: CA LPC 167) | |
| 101YP2500X Counselor, Professional (Licence: CA LPC 167) | |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2013-08-27 |