| NPI | 1821488115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 125652) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA IMF91222) |
| 101YM0800X Counselor, Mental Health (Licence: CA 125652) | |
| 171M00000X Case Manager/Care Coordinator | |
| 171M00000X Case Manager/Care Coordinator (Licence: CA 91222) | |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2021-05-13 |