| NPI | 1508428137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NM SWB-2022-1035) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NM CAD0175321) |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2023-03-20 |