| NPI | 1588926661 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 4280) |
| Additional Taxonomies | 103TE1100X Psychologist Exercise & Sports |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2012-07-20 |