| NPI | 1275632960 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 5487) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 1546-57) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2021-11-23 |