| NPI | 1790577781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: RI MHC00223-A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI CDP01044) |
| Enumeration Date | 2025-05-19 |
| Last Update Date | 2025-05-19 |