| NPI | 1639913627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 6352000499) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6351004920APP25) |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2026-02-18 |