| NPI | 1972721173 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA 801) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 4661) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2015-05-04 |