| NPI | 1114334984 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 5511) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY XXX) |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2020-10-01 |