| NPI | 1821476961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 9641) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 106H00000X Marriage & Family Therapist (Licence: CA 9641) | |
| 171M00000X Case Manager/Care Coordinator (Licence: CA APCC9641) | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2023-12-28 |