| NPI | 1144737412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA PSY10000991) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10000639) |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2025-04-24 |