| NPI | 1083763809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV 124L) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NV 0539) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2007-07-08 |