| NPI | 1598214355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NM CCMH0203221) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NM T-0182251) |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2019-05-29 |