| NPI | 1609379072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 2018017700) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AR 17-14P) |
| Enumeration Date | 2018-03-13 |
| Last Update Date | 2018-06-04 |