| NPI | 1225068547 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA MA4836) |
| Additional Taxonomies | 174400000X Specialist |
| 103TC0700X Psychologist, Clinical (Licence: MA MA4836) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2011-11-29 |