| NPI | 1316698079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM SWB-2024-0347) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2024-05-06 |