| NPI | 1558656629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10002555) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 856) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2024-10-18 |