| NPI | 1629449764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PR 4227) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PR 4227) |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2016-05-16 |