NPI | 1194090985 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV LP0109) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD #226) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 0390-LC) | |
101YP2500X Counselor, Professional (Licence: CO LPC #6108) | |
Enumeration Date | 2012-03-13 |
Last Update Date | 2017-06-04 |