| NPI | 1407203540 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY60655201) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: ID 202941) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2019-07-12 |