| NPI | 1124498423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2025-0065) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2025-10-22 |