| NPI | 1326719451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: NM SWB20220820) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM csa0219821) |
| Enumeration Date | 2021-09-28 |
| Last Update Date | 2022-11-01 |