| NPI | 1487725735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 5081) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 9264) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2007-07-18 |