| NPI | 1750975314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 162616) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 11886) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1420450221) | |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2026-07-08 |