| NPI | 1750470506 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 2007028043) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2007028043) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2018-02-15 |