| NPI | 1245451871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH16434) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI LCDP-351) |
| 101YM0800X Counselor, Mental Health (Licence: RI MHC00413) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2024-06-19 |