| NPI | 1700211539 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: GA PSY0004366) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: GA PSY0004366) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2020-08-07 |