NPI | 1780106948 |
---|---|
Former Name | BROOKE KIYO WATANABE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY22447) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY22447) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY22447) | |
103TH0004X Psychologist, Health (Licence: CA PSY22447) | |
103TH0100X Psychologist, Health Service (Licence: CA PSY22447) | |
Enumeration Date | 2017-07-10 |
Last Update Date | 2022-12-08 |