| NPI | 1609929173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NM LPCC 1047) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2017-09-07 |