| NPI | 1548594468 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810004725) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA NA) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2016-05-16 |