| NPI | 1174798375 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: WY 457) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WY 457) |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: WY 457) | |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2008-04-28 |