| NPI | 1366039836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2024-0722) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2020-12-30 |
| Last Update Date | 2024-09-06 |