| NPI | 1235753377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 103362) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB-2023-0281) |
| 1041C0700X Social Worker, Clinical (Licence: NM SWB-2023-0579) | |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2024-05-02 |