| NPI | 1275884785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0177811) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NM 0177811) |
| 101Y00000X Counselor (Licence: NM 0169001) | |
| 101YM0800X Counselor, Mental Health (Licence: NY P84090) | |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2024-06-08 |