| NPI | 1780177105 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 11467) |
| Additional Taxonomies | 103T00000X Psychologist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2021-08-02 |