NPI | 1760726640 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 05456) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 05456) |
103TF0000X Psychologist, Family (Licence: MD 05456) | |
Enumeration Date | 2012-11-16 |
Last Update Date | 2014-10-06 |