| NPI | 1932733698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 129903) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1329091118) | |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2021-12-15 |