NPI | 1134341845 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301007167) |
Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301098517) |
208000000X Pediatrics (Licence: OH 35128729) | |
Enumeration Date | 2007-05-03 |
Last Update Date | 2020-03-09 |