| NPI | 1801437322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT114404) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA SUDRC10234) |
| Enumeration Date | 2019-10-06 |
| Last Update Date | 2023-07-13 |