| NPI | 1861557076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA lcs22918) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 34234) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2024-05-21 |