| NPI | 1699018143 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 34004) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IA 105550) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2025-05-22 |