| NPI | 1538419403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: MA 241378 DESE) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: MA 241378 DESE) |
| 1041S0200X Social Worker, School (Licence: MA 241378 DESE) | |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2012-09-18 |