| NPI | 1760361158 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: MO 0331951) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MO M$$$$$$$$$) |
| Enumeration Date | 2025-08-29 |
| Last Update Date | 2025-08-29 |