| NPI | 1609112762 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 4775) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 020850) |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2015-08-27 |