| NPI | 1093178493 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TF0200X Psychologist, Forensic | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2025-01-31 |