| NPI | 1104196609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: RI MHC00626) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 11884) |
| Enumeration Date | 2011-12-31 |
| Last Update Date | 2023-06-16 |