| NPI | 1962803122 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 11613) |
| 103TC0700X Psychologist, Clinical (Licence: CA 29122) | |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2022-01-10 |