| NPI | 1083096051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV CP0214) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00479-LC) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2018-07-07 |