| NPI | 1285911792 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361003517) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: MI 6301014642) |
| 103T00000X Psychologist | |
| Enumeration Date | 2011-11-11 |
| Last Update Date | 2022-12-26 |