| NPI | 1750435376 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY9723) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 012802) |
| 103TC0700X Psychologist Clinical (Licence: GA PSY003127) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2019-03-05 |