NPI | 1326493370 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0217571) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
101YP2500X Counselor, Professional (Licence: CO 0013008) | |
Enumeration Date | 2016-04-27 |
Last Update Date | 2023-09-12 |