| NPI | 1215048376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW6002) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 106H00000X Marriage & Family Therapist (Licence: CA LMFT11656) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-06-28 |