| NPI | 1710200522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 12780) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 136906) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RA016170315) | |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2023-01-13 |