| NPI | 1407062870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 7906) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 3032698) |
| 101YS0200X Counselor, School (Licence: MA 389185) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2012-02-20 |