| NPI | 1184502692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM SWB-2025-0932) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 116696) |
| Enumeration Date | 2025-08-22 |
| Last Update Date | 2025-08-22 |