| NPI | 1922154434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 48467) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 48467) |
| 101YM0800X Counselor, Mental Health (Licence: CA 48467) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2020-09-14 |