| NPI | 1659902807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 101YM0800X Counselor, Mental Health (Licence: NM CTB-2025-0777) | |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2026-02-05 |