| NPI | 1255636585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NM 0164601) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CCMH0184991) | |
| 101YM0800X Counselor, Mental Health (Licence: NM CCMH0184991) | |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2021-11-08 |