| NPI | 1891093332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: RI MHC00496) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2011-07-01 |