| NPI | 1174764732 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY60666459) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OR 2673) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2019-05-15 |