| NPI | 1053465294 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY7277) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: GA PSY002967) |
| 103TC0700X Psychologist Clinical (Licence: NY 016569) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2011-08-22 |