| NPI | 1689742256 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810003718) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 04235) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2011-03-02 |