NPI | 1801675772 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 103T00000X Psychologist |
103TC1900X Psychologist, Counseling | |
103TC2200X Psychologist, Clinical Child & Adolescent | |
Enumeration Date | 2023-09-28 |
Last Update Date | 2024-08-02 |