| NPI | 1225229420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 6389) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: MA 434841) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2009-05-06 |