| NPI | 1982607644 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NM 654) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: NM 264001) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2021-03-12 |