| NPI | 1144259151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI LCDP00013) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI MHC00086) |
| 101YM0800X Counselor, Mental Health (Licence: MA 5216) | |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2007-07-08 |