| NPI | 1912034166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CCMH0185081) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2026-03-25 |