| NPI | 1164918827 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 06426) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810007153) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2021-03-20 |