| NPI | 1750323580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM PSY-2023-0113) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OK 145) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2024-05-30 |