| NPI | 1457410466 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 01678) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 13171) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: DC 00102) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2007-07-08 |