| 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 |