| NPI | 1104914753 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 1044) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 2003023470) |
| 103TH0100X Psychologist Health Service (Licence: MA 1783) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |