| NPI | 1053453464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 1840) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 207545) |
| 106H00000X Marriage & Family Therapist (Licence: MA 718) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |