| NPI | 1568719482 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OR 2562) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 4103) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2021-03-01 |