| NPI | 1598882342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 1279) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MA 399988) |
| 106H00000X Marriage & Family Therapist (Licence: MA 471) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-08 |