| NPI | 1972892248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CCMH0105611) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0105611) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2019-07-12 |