| NPI | 1336132356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-09887) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO CSW09923200) |
| 101YM0800X Counselor, Mental Health (Licence: NM I-05932) | |
| 101YM0800X Counselor, Mental Health (Licence: NM C-09887) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2019-07-03 |