| NPI | 1124150867 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 38636) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL PY9130) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2022-06-23 |