| NPI | 1295138717 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CT 003769) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: VA 0810005089) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2018-10-11 |