| NPI | 1134598741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 95967) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 77667) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2024-05-29 |