| NPI | 1770164501 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 285869) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2023-10-25 |