| NPI | 1760756266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID LMFT-10281) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 1331) |
| 106H00000X Marriage & Family Therapist (Licence: CA LMFT128156) | |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101006481) | |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2024-03-24 |