| NPI | 1356397665 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: LA 452) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: LA 452) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: LA 452) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2012-04-06 |