| NPI | 1629298351 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KY 163380) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 5439) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2016-12-21 |