| NPI | 1558851436 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: VA PPS-0605481) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA PPS-0605481) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2019-03-03 |