| NPI | 1790670222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM PSY-2024-0064) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 22565) |
| Enumeration Date | 2025-06-12 |
| Last Update Date | 2025-06-12 |