| NPI | 1447759873 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MT 2572) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WY 647) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MT 2572) | |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2020-08-03 |