| NPI | 1912430851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2023-02-11 |