| NPI | 1346972718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TF0000X Psychologist, Family | |
| Enumeration Date | 2022-06-25 |
| Last Update Date | 2025-06-30 |