| NPI | 1740398981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: RI RINP37097) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2012-11-19 |