| NPI | 1689760407 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QV0200X Clinic/Center VA (Licence: MA 4865) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 4865) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2015-05-22 |