NPI | 1447809777 |
---|---|
Entity Type | Individual |
Gender | N/A |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY35161) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 5112-57) |
101YM0800X Counselor, Mental Health (Licence: MI 6301018026) | |
Enumeration Date | 2019-09-09 |
Last Update Date | 2024-07-11 |