| NPI | 1306127220 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301015972) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 10005) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2014-10-27 |