| NPI | 1063603819 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 4081) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TX 33560) |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2011-05-10 |