| NPI | 1649219023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 113432) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 113432) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2017-03-23 |