| NPI | 1639727092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TX 66704) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2023-0258) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2024-08-27 |