| NPI | 1427336494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: NV CADC-I 01197) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV CADC-I 01197) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2013-07-01 |