| NPI | 1356315816 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 6877) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NH 441) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2007-07-08 |