| NPI | 1548196512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NV MI4719) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 07962-LCI) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 07961-IG) | |
| Enumeration Date | 2026-06-18 |
| Last Update Date | 2026-06-18 |