| NPI | 1407407661 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TN 3649) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN 3649) |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2025-02-04 |