| NPI | 1720154719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NV 01081) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NV 0000076723) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 1085) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2016-08-30 |