NPI | 1609938323 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 4530) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 11927) |
Enumeration Date | 2006-12-16 |
Last Update Date | 2007-07-08 |