| NPI | 1104023449 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MA 9692) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 9692) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2013-05-19 |