| NPI | 1558473611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 3472LCSW) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 5570MFC) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-10-22 |