| NPI | 1356631386 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 34162)  | 
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 34162)  | 
| Enumeration Date | 2011-04-11 | 
| Last Update Date | 2011-04-11 |