| NPI | 1881457208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 103TC0700X Psychologist, Clinical (Licence: UT 14289351-2501) | |
| Enumeration Date | 2024-01-31 |
| Last Update Date | 2026-06-21 |