| NPI | 1114562493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2023-1197) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CSA0207401) |
| 104100000X Social Worker (Licence: NM X-12018) | |
| Enumeration Date | 2019-11-11 |
| Last Update Date | 2024-08-13 |