| NPI | 1285703777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI 00140) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI LMHC00070) |
| 103T00000X Psychologist (Licence: MA 2788) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2009-07-23 |