| NPI | 1457217838 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: 1487) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB-2026-0747) | |
| Enumeration Date | 2025-12-30 |
| Last Update Date | 2026-08-31 |