| NPI | 1780825075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC 47460) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA B080717516) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MN C-4557) | |
| 106H00000X Marriage & Family Therapist (Licence: TN 1876) | |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2023-05-16 |