| NPI | 1922313188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV CADC 00213-C) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV NCACII 015096) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR CADCII 09-R-20) | |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2010-08-12 |