| NPI | 1518126226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM PSY1625) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 1492) |
| 103TC0700X Psychologist, Clinical (Licence: MS 52912) | |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2023-10-18 |