| NPI | 1013970250 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN 5171) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: UT 60174772504) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2011-01-25 |