| NPI | 1649884248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI CDP00711) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI SAP173871) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI CADC-200884) | |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2020-09-02 |