| NPI | 1306875018 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI L266287 ID6301010091) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OH 5996) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2007-07-08 |