| NPI | 1285372383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NM CTB-2022-0026) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CTB-2022-0026) |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2022-05-27 |