| NPI | 1225017163 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP2678) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MN 6046) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2007-07-08 |