| NPI | 1821396649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2026-0064) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 111290) |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2026-06-17 |