| NPI | 1053485425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 1771) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA MFT 905) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2017-09-11 |