| NPI | 1649562455 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2011011993) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 2011011993) |
| 103TC0700X Psychologist, Clinical (Licence: KS 1947) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: KS 1947) | |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2011-05-14 |