| NPI | 1639364557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0109631) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 89221) |
| 101YP2500X Counselor, Professional (Licence: NM 5523) | |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2022-09-02 |