| NPI | 1255097044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2024-0045) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM M-11141) |
| Enumeration Date | 2021-11-16 |
| Last Update Date | 2024-03-12 |