| NPI | 1104015858 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NM 1448) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 3990) |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2017-02-07 |