| NPI | 1679689517 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS 015594) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 14870) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2007-07-12 |