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 |