| NPI | 1770849010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: RI ISW02895) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 17440) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI 200020) | |
| 1041C0700X Social Worker, Clinical (Licence: MA 224236) | |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2020-12-17 |