| NPI | 1760780241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0175961) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0134631) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2021-09-07 |