| NPI | 1821757725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2026-0561) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB-2026-0165) | |
| Enumeration Date | 2021-12-08 |
| Last Update Date | 2026-08-04 |