| NPI | 1154946804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103T00000X Psychologist |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2023-10-03 |