| NPI | 1710133863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 7371) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MA 895) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2023-11-09 |