| NPI | 1831216795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: NM 0152331) |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2022-07-20 |