| NPI | 1922602879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM SWB-2025-0507) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB-2024-0154) |
| Enumeration Date | 2020-11-22 |
| Last Update Date | 2025-12-09 |