| NPI | 1801224332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM PSY1734) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NM 313091) |
| Enumeration Date | 2013-10-18 |
| Last Update Date | 2022-10-13 |