| NPI | 1851875082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CMH0202161) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM T-CTL0198311) |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2020-01-15 |