| NPI | 1053785691 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP6251) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: ND 522) |
| Enumeration Date | 2015-11-19 |
| Last Update Date | 2020-03-11 |