| NPI | 1881360634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ PSY-005792) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 103TC0700X Psychologist Clinical (Licence: NM PSY-2024-0052) | |
| 103TH0100X Psychologist Health Service | |
| Enumeration Date | 2021-08-20 |
| Last Update Date | 2024-07-16 |