| NPI | 1023264751 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KS 2024) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: KS T-LMLP1206) |
| 103TC0700X Psychologist Clinical (Licence: KS 1893) | |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2012-01-16 |