| NPI | 1649156472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM SWB-2023-0226) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: NM 402764) |
| Enumeration Date | 2025-08-15 |
| Last Update Date | 2025-08-15 |