| NPI | 1861508673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA LMHC 4173) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA LADCI 1770) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2008-07-15 |