| NPI | 1740369990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: RI MHC00428) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: RI PC372) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2022-08-18 |