| NPI | 1821716457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2023-0550) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2022-08-19 |
| Last Update Date | 2024-02-07 |