| NPI | 1104560804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2023-0618) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB-2022-0039) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2024-10-21 |