| NPI | 1225775117 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301019592) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801098054) |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2025-02-13 |