| NPI | 1396921292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: RI MHC00870) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI LCDP 00417) |
| 101YP2500X Counselor, Professional (Licence: CT 3738) | |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2020-09-24 |