| NPI | 1346566122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist School (Licence: MA 284419) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 284419) |
| 101YS0200X Counselor School (Licence: MA 284419) | |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2010-04-19 |