| NPI | 1144378761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI LCDP00090) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW00072) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |