| NPI | 1235200791 |
|---|---|
| Former Name | DIANE KAY SANDRUM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP1489) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP1489) |
| 103TF0200X Psychologist, Forensic (Licence: MN LP1489) | |
| 103TH0004X Psychologist, Health (Licence: MN LP1489) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2024-10-16 |