| NPI | 1881930758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 101YS0200X Counselor School | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: MA S56441418) | |
| Enumeration Date | 2012-12-21 |
| Last Update Date | 2012-12-21 |