| NPI | 1790981090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00506-L) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NV 0862) |
| Enumeration Date | 2007-06-23 |
| Last Update Date | 2007-07-08 |