| NPI | 1962498584 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 1501) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY29547) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2017-12-20 |