| NPI | 1902318504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810003249) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810003249) |
| 103TF0200X Psychologist Forensic (Licence: VA 0810003249) | |
| Enumeration Date | 2017-11-04 |
| Last Update Date | 2017-11-04 |