| NPI | 1790176444 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CO 4090) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 4090) |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2020-01-30 |