| NPI | 1831618784 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 38721) | 
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA A6) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-09-12 | 
| Last Update Date | 2022-04-14 |