| NPI | 1215728175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM SWB-2024-0789) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 113862) |
| Enumeration Date | 2025-05-13 |
| Last Update Date | 2025-05-13 |