| NPI | 1619395142 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN 3232) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: VA 0810004955) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2014-08-21 |