| NPI | 1194131060 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301016825) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301016825) |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2020-10-20 |