| NPI | 1174963003 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TE1100X Psychologist, Exercise & Sports (Licence: MA 10902) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 10902) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2013-06-25 |