| NPI | 1144520370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 1079) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 205340) |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2010-10-21 |