| NPI | 1447599717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NV 01324) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NV 10761) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2013-02-06 |
| Last Update Date | 2015-06-16 |