| NPI | 1447538004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: RI MHC00933) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2010016109) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2020-09-03 |