| NPI | 1013939313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCS13942) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC19448) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2010-01-27 |