| NPI | 1760180384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB-2023-0150) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NM 1528) |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2026-05-19 |