| NPI | 1770898827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2024-0286) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09924110) |
| 1041C0700X Social Worker, Clinical (Licence: CA 92609) | |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2025-03-18 |