NPI | 1780054650 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 127690) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Enumeration Date | 2015-10-05 |
Last Update Date | 2023-01-10 |