| NPI | 1477335909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2025-0139) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM SWB-2022-0109) |
| Enumeration Date | 2023-10-18 |
| Last Update Date | 2025-03-17 |