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 |