| NPI | 1760353452 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KY 295414) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: KY 295414) |
| Enumeration Date | 2025-09-15 |
| Last Update Date | 2025-10-09 |