| NPI | 1982955076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFT 25330) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CAS - 3667) |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2023-11-01 |