| NPI | 1447443247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: RI MHC00396) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: RI C159) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2009-04-02 |