| NPI | 1992274914 |
|---|---|
| Former Name | WHITNEY MACKENZIE BLISS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 023720) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 38389) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2020-10-16 |