| NPI | 1093167009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 01512-L) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NV CI0216) |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2016-07-01 |