| NPI | 1841564978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV CP0162) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV CP0162) |
| 101YM0800X Counselor, Mental Health (Licence: NH 1169) | |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2024-05-28 |