| NPI | 1124005129 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 00258) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IA 00666) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2015-01-15 |