| NPI | 1164433165 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN MN 4364) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN MN 4364) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-07-09 |