| NPI | 1700157526 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PR 4189) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PR 4189) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PR 4189) | |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2012-01-25 |