| NPI | 1124224290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YS0200X Counselor, School (Licence: MA 273341) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MA 753) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2007-07-08 |