| NPI | 1043311871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: RI MHC00346) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: RI PC226) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-08-09 |