| NPI | 1568733103 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810004071) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY523) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2012-01-12 |