| NPI | 1053760918 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 1232) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN cc01232) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2020-08-24 |