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 |