| NPI | 1871399808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 21417) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 20645) |
| 106H00000X Marriage & Family Therapist (Licence: CA 160271) | |
| Enumeration Date | 2025-02-20 |
| Last Update Date | 2025-12-11 |