| NPI | 1346863693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 115082) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MA 115082) |
| 101YP2500X Counselor, Professional (Licence: MA 115082) | |
| 101YS0200X Counselor, School | |
| 104100000X Social Worker (Licence: MA 115082) | |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2020-06-05 |