| NPI | 1639943483 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KY 287241) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: KY 287241) |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2023-11-22 |