| NPI | 1346808789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: RI MHC01606) |
| Additional Taxonomies | 101Y00000X Counselor |
| 225200000X Physical Therapy Assistant (Licence: MA 876433) | |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2025-11-03 |