| NPI | 1013979392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MA 103) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 202045) |
| 106H00000X Marriage & Family Therapist (Licence: MA 129) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2007-07-08 |