| NPI | 1316475064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA LMHC11231) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI MHC01947) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA LMHC11231) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI MHC01947) | |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2026-02-10 |