| NPI | 1649292574 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 8056) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY1920) |
| 103TC0700X Psychologist, Clinical (Licence: MD 3446) | |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2007-07-08 |