| NPI | 1750541470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: NM 292962) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM T-0111881) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2024-06-03 |