| NPI | 1316536865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103T00000X Psychologist |
| 104100000X Social Worker | |
| 101Y00000X Counselor | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2026-08-31 |