| NPI | 1982768693 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY10428) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist Clinical (Licence: TX 14063) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2019-07-05 |