| NPI | 1982037511 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KS 2147) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA 14231) |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2022-10-30 |