| NPI | 1447098660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TS0200X Psychologist, School (Licence: TX 71724) | |
| Enumeration Date | 2024-07-20 |
| Last Update Date | 2024-07-20 |