| 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 |