| NPI | 1922580646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NV IC-2402) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV 06790-C) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV 02376-I) | |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2025-07-15 |