| NPI | 1447511605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CCMH0219991) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC0017517) |
| 101YM0800X Counselor, Mental Health (Licence: OK LPC6141) | |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2025-11-10 |