| NPI | 1285264903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM C-11895) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker | |
| 104100000X Social Worker | |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2022-07-18 |