| NPI | 1508844135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM PA9501) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM 1157) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2007-07-08 |