| NPI | 1366187775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CSA0223681) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM SWB-2024-0962) |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2024-12-06 |