| NPI | 1053759068 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 11724) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103G00000X Clinical Neuropsychologist | |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2022-03-02 |