| NPI | 1689230955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2023-0565) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: CA 98555) | |
| 104100000X Social Worker (Licence: NM SWB-2023-0565) | |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2023-12-01 |