| NPI | 1043555626 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: WA PY 60262779) |
| Additional Taxonomies | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: WA PY 60262779) |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2012-12-07 |