| NPI | 1255801494 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 38304) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 022780) |
| Enumeration Date | 2018-11-30 |
| Last Update Date | 2020-04-08 |