| NPI | 1801362678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CTB-2023-0430) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM T-CTL0199741) |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2024-07-26 |