| NPI | 1083951693 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301016736) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810004689) |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2022-04-08 |