| NPI | 1588261945 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY004435) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PSY004435) |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2022-07-12 |