| NPI | 1952822611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM PSY-2025-0115) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY36811) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2026-07-24 |