| NPI | 1306242045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: RI MHC01085) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI CDP00535) |
| Enumeration Date | 2014-11-07 |
| Last Update Date | 2019-08-14 |