| NPI | 1275694614 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810001892) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: VA 0803000078) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |