| NPI | 1407046535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NV 4913S) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 01168-L) |
| 1041C0700X Social Worker, Clinical (Licence: NV IC-504) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2023-08-29 |