| NPI | 1053850636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 0529-LC) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00689-C) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RA8750817) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CAD0196351) | |
| 101YM0800X Counselor, Mental Health (Licence: NM T-CTL0193941) | |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2019-03-22 |