| NPI | 1245907831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 07685-C) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NV 07839-CG) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2026-07-22 |