| NPI | 1497121180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-10810) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NM 85-0338552) |
| 104100000X Social Worker (Licence: NM X-09656) | |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2021-10-22 |