| NPI | 1134353824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 07795-I) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NV PRSS-SUP-5097) |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2024-07-22 |