| NPI | 1063591782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0119791) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM T0094441) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2014-06-12 |