| NPI | 1720062490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 1546) |
| Additional Taxonomies | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: OR 200870007CNS-PP) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2013-01-09 |