| NPI | 1194843433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NV 00196-L) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00196-L) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-09 |