| NPI | 1659631935 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 05118) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC 1000795) |
| 103TC0700X Psychologist, Clinical (Licence: NY 019034) | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2015-06-01 |