| NPI | 1275818676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: RI ISW02285) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: RI CDS00058) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: RI CDP00186) | |
| 1041C0700X Social Worker Clinical (Licence: CT 008129) | |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2013-03-06 |