| NPI | 1588648596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 00703) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IA 00703) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2021-08-01 |