| NPI | 1215205877 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 9451) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CT 2887) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2011-12-21 |