| NPI | 1205203965 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP6096) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY27506) |
| 103TC0700X Psychologist, Clinical (Licence: WI 3459-57) | |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2018-03-17 |