| NPI | 1609845023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 4135) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MA 317014) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2009-12-11 |