| NPI | 1104171792 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NM PSY1626) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM PSY1626) |
| 103T00000X Psychologist (Licence: VA 0810008276) | |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2025-09-18 |