| NPI | 1205369089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0017982) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NM T-0184881) |
| 101YP2500X Counselor, Professional (Licence: NM ccmh0211921) | |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2023-08-17 |