| NPI | 1447573340 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0172941) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CCMH0172941) |
| Enumeration Date | 2010-03-05 |
| Last Update Date | 2024-01-19 |