| NPI | 1487974838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI 2179) |
| Additional Taxonomies | 101YS0200X Counselor, School |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2024-07-15 |