| NPI | 1346067964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2026-0200) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO LSW.0009925204) |
| 1041C0700X Social Worker, Clinical (Licence: RI ISW04221) | |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2026-03-05 |