| NPI | 1588085070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CCMH0194731) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0174401) |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2018-03-06 |