| NPI | 1104380401 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY61300930)  | 
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810007722)  | 
| 103TC0700X Psychologist, Clinical (Licence: DC PSY200001564)  | |
| Enumeration Date | 2019-01-31 | 
| Last Update Date | 2024-08-01 |