| NPI | 1992348403 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TC0700X Psychologist, Clinical (Licence: CA 34730) | |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2024-12-10 |