| NPI | 1235543786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM PSY-2023-0102) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ PSY-005395) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2024-04-23 |