| NPI | 1053766592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NM SWB-2023-1176) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 104100000X Social Worker (Licence: NM M-10378) | |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2023-12-06 |