NPI | 1346772589 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health |
Additional Taxonomies | 103T00000X Psychologist |
103TC0700X Psychologist, Clinical (Licence: FL PY11285) | |
103TC0700X Psychologist, Clinical (Licence: GA PSY004688) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-03-28 |
Last Update Date | 2023-04-21 |