| NPI | 1700905114 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KS 1237) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MO R0501) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-08 |