NPI | 1245867068 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CO CSW.09930686) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-03-23 |
Last Update Date | 2024-07-25 |