| NPI | 1114237765 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: UT 8109989-2501) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 6301014440) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2012-11-06 |