| NPI | 1538265186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH2830) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM M-0450) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2026-04-24 |