| NPI | 1225388911 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6361000775) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 2946140) |
| 103T00000X Psychologist (Licence: MI 6301014798) | |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2022-08-09 |