| NPI | 1023370418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 2120228) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 13040) |
| 101YM0800X Counselor, Mental Health (Licence: RI MHC01539) | |
| 1041C0700X Social Worker, Clinical (Licence: RI CSW04003) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2026-02-20 |