| NPI | 1295486769 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 080502241) |
| Enumeration Date | 2022-01-15 |
| Last Update Date | 2022-01-15 |