| NPI | 1578694782 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 5549) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 010484) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2007-10-09 |