| NPI | 1255958799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 07761-C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NV 4160-S) |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2024-09-16 |