| NPI | 1063078384 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-17-25337) |
| 103TC0700X Psychologist, Clinical (Licence: MD 06416) | |
| 103TC0700X Psychologist, Clinical (Licence: TX 38644) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2023-03-23 |