| NPI | 1649600479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MA S30292652) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MA S30292652) |
| 101YM0800X Counselor, Mental Health (Licence: MA S30292652) | |
| 103T00000X Psychologist (Licence: MA S30292652) | |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2013-11-14 |