| NPI | 1629314679 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 111710) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY KY-1757) |
| Enumeration Date | 2012-12-19 |
| Last Update Date | 2024-06-18 |