| NPI | 1558665513 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 4112) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: MA 4112) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2011-01-05 |