| NPI | 1750115952 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 000000) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports (Licence: KY 0000000) |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2024-10-08 |