| NPI | 1932517851 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WY 739) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2025-05-08 |