| NPI | 1700742244 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH P.08906) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH P.08906) |
| Enumeration Date | 2025-12-29 |
| Last Update Date | 2026-02-11 |