| NPI | 1851171557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2026-0748) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM SWB-2023-0902) |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2026-08-03 |