| NPI | 1619378650 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301016051) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810005172) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY10662) | |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2021-12-09 |