| NPI | 1154154870 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0006297) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 36553) |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2026-07-11 |