| NPI | 1700460904 |
|---|---|
| Other Name | MAC ELLIOT PORTER |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2024-08-12 |