| NPI | 1083152524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2023-0904) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW17993) |
| 104100000X Social Worker (Licence: NM SWB-2023-0904) | |
| 104100000X Social Worker (Licence: FL SW17993) | |
| Enumeration Date | 2017-02-04 |
| Last Update Date | 2026-03-05 |