| NPI | 1578113569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2025-01-23 |