| NPI | 1366035834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NM CTB20250426) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2023-0133) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-02-16 |
| Last Update Date | 2025-08-20 |