| NPI | 1356570238 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301016513) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301014037) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2016-07-15 |