| NPI | 1821469248 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810007912) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301017856) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2022-08-04 |