| NPI | 1790999811 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: SC 501) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TN 548) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-07-08 |