| NPI | 1396124004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 12605) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 6691) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-05-27 |