| NPI | 1922368604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 1719) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MA 358) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2012-05-29 |