| NPI | 1750425179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MA 102778) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 102778) |
| 101YP2500X Counselor Professional (Licence: MA 102778) | |
| 101YS0200X Counselor School (Licence: MA 102778) | |
| 104100000X Social Worker (Licence: MA 102778) | |
| 1041C0700X Social Worker Clinical (Licence: MA 102778) | |
| 106H00000X Marriage & Family Therapist (Licence: MA 102778) | |
| Enumeration Date | 2007-02-18 |
| Last Update Date | 2007-07-08 |