| NPI | 1053504597 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301016458) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301016458) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY22977) | |
| Enumeration Date | 2007-08-18 |
| Last Update Date | 2019-07-02 |