| NPI | 1407169493 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KY 245094) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 2010-106 TEMP) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2022-01-27 |