| NPI | 1124884622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CTB-2025-0011) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: student) |
| Enumeration Date | 2024-02-23 |
| Last Update Date | 2025-09-18 |