| NPI | 1366738270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV CP0174) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00417-LC) |
| 101YP2500X Counselor, Professional (Licence: NV CP0174) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2018-11-19 |