| NPI | 1851443790 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: NM 0062712) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NM 0062712) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-07-09 |