| NPI | 1033341748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM PSY-2025-0062) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS016663) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2025-07-09 |