| NPI | 1487707006 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS000363L) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: PA PS000363L) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-07-09 |