| NPI | 1659395812 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 25100) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: TX 2-5100) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 2-5100) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 2-5100) | |
| 246ZE0500X Specialist/Technologist, Other, EEG | |
| 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2012-07-09 |