NPI | 1104064880 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 2913-057) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071.007598) |
Enumeration Date | 2009-02-03 |
Last Update Date | 2012-10-03 |