| NPI | 1811186778 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 36866) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 2007-72) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2014-08-27 |