| NPI | 1710218516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-10327) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CAD0189011) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2010-01-19 |
| Last Update Date | 2023-07-15 |