| NPI | 1063708469 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA TE60228917) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MD 04576) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2011-06-23 |