| NPI | 1194458174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2023-05-19 |