| NPI | 1942855671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM CTB-2025-0760) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CSA0204901) |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2025-12-03 |