| NPI | 1467089151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB-2024-0709) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: ccss) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-12-23 |