| NPI | 1184659914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS16404) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC27844) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2013-03-01 |