| NPI | 1518167394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0183181) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AR P15112129) |
| 101YP2500X Counselor, Professional (Licence: CO 5511) | |
| 106H00000X Marriage & Family Therapist (Licence: NM CMF0187581) | |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2021-11-15 |