| NPI | 1932845237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA PSY10000879) |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2024-07-09 |