| NPI | 1336985464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NM CTB-2024-0484) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB20240484) |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2025-07-23 |