| NPI | 1134103260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW01299) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI LCDP00015) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI LCDS00025) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2016-03-31 |