| NPI | 1336177799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW00666) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI LCDP00349) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2008-07-08 |