| NPI | 1730412867 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: SD 680) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MN 5095) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2025-04-10 |