| NPI | 1255302857 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OH 5994) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: KY 1320) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2007-07-10 |