| NPI | 1649544735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NV CP5226-R) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00714-C) |
| 101YP2500X Counselor, Professional (Licence: NV CI636) | |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2023-08-29 |