| NPI | 1679059828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CMH0201861) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM T-CTL0197251) |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2019-03-27 |