| NPI | 1104208586 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WV 1175) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301016315) |
| 103T00000X Psychologist (Licence: WV 1175) | |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2023-05-25 |