| NPI | 1366515587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NV 0824) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00231L) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 276-LC) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2019-08-26 |