| NPI | 1710040829 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY8534) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL FL Lic PY5930) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2013-03-26 |