| NPI | 1689661688 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ 3493) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 014803 1) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2018-03-19 |