NPI | 1043615073 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY29622) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 29622) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2014-11-04 |
Last Update Date | 2023-04-11 |