| NPI | 1700111358 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 103TC0700X) |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2018-03-17 |