| NPI | 1134215619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 5882) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM PSY-2026-0009) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2026-03-25 |