| NPI | 1720575780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NV CP5003) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NV CI660) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV 00341) | |
| 101YM0800X Counselor Mental Health (Licence: WA LH61413920) | |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2025-06-26 |