| NPI | 1679217921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 07832-PC) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NV 11294-S) |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2024-10-11 |