| NPI | 1013906478 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810003763) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY19714) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2014-03-19 |