| NPI | 1508646373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO CSW-1858) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NM SWB-2024-0219) |
| Enumeration Date | 2023-09-29 |
| Last Update Date | 2024-03-29 |