| NPI | 1386712636 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 4216) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports (Licence: MA 4216) |
| Enumeration Date | 2006-12-02 |
| Last Update Date | 2007-07-08 |