NPI | 1689040156 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 87136) |
Enumeration Date | 2015-08-19 |
Last Update Date | 2021-08-16 |