NPI | 1548713829 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.08718) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
101YM0800X Counselor, Mental Health | |
Enumeration Date | 2016-08-03 |
Last Update Date | 2024-10-28 |