| NPI | 1255683256 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2014029000) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 3047) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WI 3047) | |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2014-08-29 |