| NPI | 1972973832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103G00000X Clinical Neuropsychologist (Licence: OR 3652) | |
| Enumeration Date | 2015-10-04 |
| Last Update Date | 2023-05-17 |