| NPI | 1164066254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2023-0349) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2023-07-31 |