| NPI | 1649616772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NM CCMH0193371) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NM 0117781) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NM 0092621) | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2024-11-14 |