| NPI | 1447814835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI CDP01070) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI CSW04393) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2026-06-16 |