| NPI | 1386855252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0123991) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM 123991) |
| 103TS0200X Psychologist, School (Licence: NM 375345) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2025-01-09 |