| NPI | 1386318079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2024-0777) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 105574) |
| Enumeration Date | 2021-08-05 |
| Last Update Date | 2024-08-07 |