| NPI | 1720575780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00341) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NV CI660) |
| 101YM0800X Counselor, Mental Health (Licence: NV CP5003) | |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2024-02-22 |