| NPI | 1063566339 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 7240) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 696) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2011-11-01 |