| NPI | 1346499795 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY10657) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY61251624) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2022-04-08 |