| NPI | 1740689611 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810004993) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: SC 1347) |
| Enumeration Date | 2014-08-17 |
| Last Update Date | 2015-03-18 |