| NPI | 1497395396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CMH0208951) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 19509) |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2026-01-06 |