| NPI | 1053628610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MA 875586) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2010-09-02 |