| NPI | 1366739922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MA 530) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 521) |
| 1041C0700X Social Worker, Clinical (Licence: MA 207269) | |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2017-03-28 |