NPI | 1902129422 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV CP0197) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00408-LC) |
Enumeration Date | 2010-03-11 |
Last Update Date | 2024-06-06 |