| NPI | 1447625777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2023-0171) |
| Additional Taxonomies | 101Y00000X Counselor |
| 247200000X Technician, Other | |
| Enumeration Date | 2015-12-11 |
| Last Update Date | 2024-11-11 |