| NPI | 1386012912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB-2023-0036) |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2023-03-22 |