| NPI | 1245394147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 3881) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 111706) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2007-07-09 |