| NPI | 1053392993 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: GA PSY002931) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NH 349) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2007-07-16 |