| NPI | 1801152608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MA s12281707) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA s12281707) |
| 104100000X Social Worker (Licence: MA s12281707) | |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2012-04-05 |