| NPI | 1962106815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: NM 415724) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: NM SWB-2022-0985) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2025-08-18 |