| NPI | 1265458541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: RI MHC00072) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI CDS00011) |
| 101YM0800X Counselor, Mental Health (Licence: MA 8760) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2019-08-23 |