| NPI | 1740348259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NV 5732-C) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFT13320) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2010-08-09 |