| NPI | 1063954626 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301016870) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MI PP0000000891687) |
| Enumeration Date | 2016-11-14 |
| Last Update Date | 2016-11-14 |