| NPI | 1124212972 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 129842) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY 1745) |
| 103TC0700X Psychologist, Clinical (Licence: KY 2012-12) | |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2024-09-30 |