| NPI | 1023416807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP6046) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 3820-57) |
| Enumeration Date | 2014-12-10 |
| Last Update Date | 2025-10-02 |