| NPI | 1275926172 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 10734) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 10734) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2020-09-30 |