| NPI | 1497196109 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: GA PSY003735) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2013-11-01 |