| NPI | 1124537527 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6362000477) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2021-05-25 |