| NPI | 1114637048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB-2022-0702) |
| Additional Taxonomies | 1041S0200X Social Worker, School |
| Enumeration Date | 2022-12-01 |
| Last Update Date | 2025-02-21 |