NPI | 1699018143 |
---|---|
Entity Type | Individual |
Gender | N/A |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 105550) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 34004) |
Enumeration Date | 2013-04-03 |
Last Update Date | 2024-11-05 |