| NPI | 1215088554 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OH 6252) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: KY 1430) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2007-07-08 |