| NPI | 1962385906 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program | 
| Additional Taxonomies | 103TC1900X Psychologist, Counseling | 
| Enumeration Date | 2025-07-28 | 
| Last Update Date | 2025-07-28 |