| NPI | 1992052179 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: IA 079618) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY27110) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2019-01-03 |