| NPI | 1649414673 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MD 3134) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: DC 1833) |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2009-04-21 |