| NPI | 1144599317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 1023429) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MA 335996) |
| Enumeration Date | 2011-12-17 |
| Last Update Date | 2012-01-04 |