| NPI | 1306848361 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MD 3665) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AL 1394) |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2007-07-08 |