| NPI | 1750080941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB-2023-0571) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM SWB-2026-0327) |
| Enumeration Date | 2023-02-27 |
| Last Update Date | 2026-03-17 |