NPI | 1104550490 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY11524) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY11524) |
103T00000X Psychologist (Licence: FL PY11524) | |
Enumeration Date | 2022-07-12 |
Last Update Date | 2025-07-29 |