| NPI | 1245263961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist School |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: VA 0810002799) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2018-05-23 |