| NPI | 1841404654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: RI MHC00506) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 7058) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2011-06-09 |