| NPI | 1144378761 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW00072) | 
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI LCDP00090) | 
| Enumeration Date | 2007-01-08 | 
| Last Update Date | 2025-05-02 |