| NPI | 1346758786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 02564-I) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2018-01-19 |
| Last Update Date | 2019-11-06 |