| NPI | 1780097956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2023-0196) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0023121) |
| 101YP2500X Counselor, Professional (Licence: AL 3540) | |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2025-11-25 |