| NPI | 1124162763 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 00568) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IA 00568) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2007-07-08 |