| NPI | 1306955810 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301006054) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MI 6801063633) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |