| NPI | 1891312633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 101YS0200X Counselor, School | |
| 103T00000X Psychologist | |
| 103TC1900X Psychologist, Counseling | |
| 103TH0004X Psychologist, Health | |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2020-06-27 |
| Last Update Date | 2020-06-30 |