| NPI | 1760672125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 93723) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 106H00000X Marriage & Family Therapist (Licence: CA IMF87798) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2021-08-13 |