| NPI | 1760447585 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 39542) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: GA 1969) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2025-03-13 |