| NPI | 1518374669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NM T-0164331) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM ccmh0198861) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2022-08-18 |