| NPI | 1770017139 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS018821) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2019-08-26 |