| NPI | 1770532616 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 35059) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL PY 6175) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2011-09-28 |