| NPI | 1912120429 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS016046) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NJ 061-A302) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-08 |