| NPI | 1952669061 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MA 9170) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MA 1970) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2012-11-21 |