| NPI | 1235294018 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO 01757) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MO 01757) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 01757) | |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2019-10-11 |