| NPI | 1962942508 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CMH0186181) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0186181) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2025-03-03 |