| NPI | 1861025686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB-2024-0501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2026-0064) |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2026-05-28 |