| NPI | 1215601992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NM SWB20240726) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NM CSA0218251) |
| Enumeration Date | 2021-08-05 |
| Last Update Date | 2025-06-16 |