| NPI | 1356830046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CTB-2024-0847) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM T2CTL0195861) |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2026-03-31 |