| NPI | 1063417541 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 25820) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OK 768) |
| 103T00000X Psychologist (Licence: MI 6301009400) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2008-03-07 |