| NPI | 1962794685 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810004779) |
| 103TC0700X Psychologist Clinical (Licence: VA 0810004779) | |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2013-05-02 |