| NPI | 1700233517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CCMH0198731) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CAD0209021) |
| Enumeration Date | 2016-05-21 |
| Last Update Date | 2021-10-25 |