| NPI | 1780858068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2024-1135) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW60242) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2026-01-14 |