| NPI | 1912520842 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MD 06355) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: TX 36042) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2020-07-27 |