| NPI | 1992728588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC22477) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA MFC22477) |
| 101YM0800X Counselor, Mental Health (Licence: CA MFC22477) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2007-10-11 |