| NPI | 1972856243 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 9511) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 9511) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2012-10-23 |