| NPI | 1659035178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 06751-L) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NV 06850-CG) |
| Enumeration Date | 2021-10-30 |
| Last Update Date | 2021-10-30 |