| NPI | 1295933737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV #00361-C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NV #4994-S) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2013-06-05 |