| NPI | 1700284270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2025-0275) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-19906) |
| Enumeration Date | 2014-12-15 |
| Last Update Date | 2025-05-01 |