| NPI | 1366422206 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WY 256) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 1972) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2007-07-08 |