| NPI | 1558344523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 105716) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 105716) |
| 106H00000X Marriage & Family Therapist (Licence: MA 105716) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2007-07-08 |