| NPI | 1124044938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NV MFT #0694) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV LADC #782) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2021-11-24 |