| NPI | 1962077453 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TE1100X Psychologist Exercise & Sports (Licence: GA PSY004384) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: GA PSY004384) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2021-05-26 |