| NPI | 1073944914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 27269) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 20299) |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2015-03-19 |