| NPI | 1962543058 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2013007642) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NH 1139) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 24150) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2016-05-04 |