| NPI | 1386382372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ PSY-005525) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NM PSY-2022-0046) |
| Enumeration Date | 2022-05-20 |
| Last Update Date | 2025-04-18 |