| NPI | 1356180384 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB-2024-0713) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-12-19 |