| NPI | 1093388712 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008267) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2024-09-10 |