| NPI | 1245514504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV 01455-L) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NV 6095-S) |
| 104100000X Social Worker (Licence: IA 007004) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2017-05-05 |