| NPI | 1811275498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 01495-L) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NV 6331-S) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2013-06-25 |