| NPI | 1134302722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NM LPCC 0088061) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CA MFC 2017) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2008-04-07 |