| NPI | 1790771780 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 0000775) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: HI 1438) |
| 103T00000X Psychologist (Licence: AZ 3522) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2021-01-25 |