| NPI | 1376868620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV IC-2476) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 1057-L) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2025-02-14 |