| NPI | 1033877477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM SWB-2026-0047) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NM 1499) |
| Enumeration Date | 2021-12-02 |
| Last Update Date | 2026-01-16 |