| NPI | 1275118192 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN LP4946) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: WI 1492) |
| 103TC0700X Psychologist Clinical (Licence: WI 1492) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MN LP4946) | |
| Enumeration Date | 2021-03-11 |
| Last Update Date | 2021-03-11 |