| NPI | 1245597244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NV 01321) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV 00403-LC) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2016-10-01 |