| NPI | 1316527351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CTB-2025-0519) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-18322) |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2025-08-21 |