| NPI | 1659752830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 104379) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 106H00000X Marriage & Family Therapist (Licence: CA 104379) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2015-06-14 |
| Last Update Date | 2023-03-13 |