| NPI | 1396464772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM SWB-2024-1305) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2025-02-11 |