| NPI | 1184829145 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AL 2115) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY27574) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2021-01-17 |