| NPI | 1760556468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LL7587) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MR 14179) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2021-12-06 |