NPI | 1972114635 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2020-08-14 |
Last Update Date | 2023-12-05 |