| NPI | 1447722988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NM CTB-2023-0586) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CCH0198821) |
| 101YM0800X Counselor, Mental Health (Licence: NM CMH0198821) | |
| Enumeration Date | 2018-12-21 |
| Last Update Date | 2024-12-12 |