| NPI | 1962893305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: RI MHC00954) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 1156) |
| 101YP2500X Counselor, Professional (Licence: CT 5178) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 14120) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI CDP00609) | |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2025-10-03 |