| NPI | 1750718136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 103T00000X Psychologist | |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2018-04-09 |