| NPI | 1972671261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 117405) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 4592) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2016-12-22 |