| NPI | 1669016531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2020-10-02 |