| NPI | 1497080147 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2572) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 018322) |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2016-09-14 |