| NPI | 1104090646 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP5379) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 3561-57) |
| 103TC0700X Psychologist, Clinical (Licence: NY 017260) | |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2021-01-14 |