| NPI | 1245508688 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: CA 25712) |
| Additional Taxonomies | 103TE1100X Psychologist Exercise & Sports (Licence: CA 25712) |
| 103TF0000X Psychologist Family (Licence: CA 25712) | |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2011-12-13 |