| NPI | 1215205778 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CT 003081) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 018791-1) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2011-12-12 |