| NPI | 1952921223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CTB-2022-0915) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CMH0210781) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2022-12-06 |