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 |