| NPI | 1326346214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CCMH0145631) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2024-01-04 |