| NPI | 1790208221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 3135) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2025-08-19 |