| NPI | 1871703793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA LMFT45786) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CATCt B0504111305) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2015-08-14 |