| NPI | 1013679091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 36582) |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2021-10-07 |