| NPI | 1104862077 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 36945) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IL 071006779) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2021-03-15 |