| NPI | 1215360995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NM CCMH0185641) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM ccmh0185641) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2025-01-23 |