| NPI | 1720564941 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 10954) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2023-12-06 |