| NPI | 1891977815 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OR 2021) |
| Additional Taxonomies | 103TE1100X Psychologist Exercise & Sports (Licence: OR 2021) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2012-04-12 |