| NPI | 1447645346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NV 10313-C) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV 07258-LC) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2023-06-07 |