| NPI | 1285619452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW01318) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI LCDP00297) |
| Enumeration Date | 2005-12-10 |
| Last Update Date | 2013-07-29 |