| NPI | 1871762526 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: PR 3040) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PR 3040) |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2011-09-08 |