| NPI | 1871939959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NV 01022) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NV 00125CG) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00197) | |
| 106H00000X Marriage & Family Therapist (Licence: CA 39526) | |
| 106H00000X Marriage & Family Therapist (Licence: NM 0145071) | |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2013-05-16 |