| NPI | 1497501175 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY.0006533) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY P121589) |
| Enumeration Date | 2024-04-24 |
| Last Update Date | 2024-10-07 |