| NPI | 1043507452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NV 01142) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 01280-L) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2013-05-15 |