| NPI | 1700385432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CCMH0203081) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CMH0194381) |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2019-04-09 |