| NPI | 1477056562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CMH0198921) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11500) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CAD0198431) | |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2019-09-17 |