| 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 | 2025-09-09 |