| NPI | 1588902712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0177551) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM T-0156331) |
| 101YP2500X Counselor, Professional (Licence: NM 0177551) | |
| Enumeration Date | 2013-01-23 |
| Last Update Date | 2021-05-03 |