NPI | 1225407364 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 9212) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 17059) |
Enumeration Date | 2015-09-18 |
Last Update Date | 2015-09-18 |