| NPI | 1568203206 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 35067) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 35067) |
| 103TA0700X Psychologist, Adult Development & Aging | |
| 103TF0000X Psychologist, Family (Licence: CA 35067) | |
| 103TH0004X Psychologist, Health (Licence: CA 35067) | |
| Enumeration Date | 2024-06-05 |
| Last Update Date | 2024-06-14 |