NPI | 1912474230 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA AMFT132784) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Ci28840120) |
Enumeration Date | 2018-10-24 |
Last Update Date | 2022-08-16 |