NPI | 1023202710 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 33172) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WI 3112-57) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS017601) | |
Enumeration Date | 2007-09-05 |
Last Update Date | 2023-08-27 |