| NPI | 1497953798 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 8502) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: VT 808) |
| Enumeration Date | 2007-07-07 |
| Last Update Date | 2007-07-08 |