| NPI | 1114279171 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 013592) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MO 2011019829) |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2012-10-15 |