| NPI | 1750640645 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC PSY1000781) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301013748) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2012-05-11 |