| NPI | 1508074493 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NH 709) |
| Additional Taxonomies | 103TE1100X Psychologist Exercise & Sports (Licence: NH 709) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-09 |