| NPI | 1205073749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 4027) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MA 365449) |
| 1041S0200X Social Worker, School (Licence: MA 365449) | |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2009-01-20 |