| NPI | 1699353961 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 269913) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 06444) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2021-09-21 |