| NPI | 1962483479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NM 150) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: NM 240433) |
| 103T00000X Psychologist (Licence: 3734) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2013-03-26 |