| NPI | 1376879296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM C-11864) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CAD0157991) |
| 1041C0700X Social Worker, Clinical (Licence: NM C-11864) | |
| Enumeration Date | 2009-10-28 |
| Last Update Date | 2025-07-22 |