| NPI | 1043254543 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KS 961) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MO PY01716) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2014-11-12 |