| NPI | 1316475064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 11231) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI MHC01947) |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2025-12-17 |