| NPI | 1922404045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 121048) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 8747-R) |
| 106H00000X Marriage & Family Therapist (Licence: CA 81257) | |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2024-09-06 |