| NPI | 1295734929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NM SWB-2022-1105) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CO CSW.09924447) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2025-07-31 |