| NPI | 1912006024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM PSY-2025-0107) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY22883) |
| 103TC0700X Psychologist, Clinical (Licence: NM PSY1675) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2025-08-18 |