| NPI | 1780744581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 1688) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN25219) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2025-09-11 |