| NPI | 1114168762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WY 486) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS016601) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2010-05-20 |