| NPI | 1629353016 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CT 001867) |
| Additional Taxonomies | 103TH0004X Psychologist Health (Licence: CT 001867) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2011-10-17 |