| NPI | 1497877575 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0000X Psychologist, Family (Licence: CT 3003) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 3003) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CT 3003) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CT 3003) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2014-01-02 |