| NPI | 1780161091 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 11051) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: UT 7771439-2501) |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2022-09-07 |