| NPI | 1730857871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301018288) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301018288) | |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2022-07-18 |