| NPI | 1144765504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS018750) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MD 05884) |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2021-10-25 |