| NPI | 1497145528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV CP1289) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00576-LC) |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2024-08-05 |