| NPI | 1699042630 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC 1000504) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 04550) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2011-11-18 |