| NPI | 1750625653 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810004581) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: KY 1554) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |