| NPI | 1003375817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0225461) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM T-CTL0202461) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2022-07-21 |