| NPI | 1225107758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MA MH-1497-CC) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 1497) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2015-03-03 |