| NPI | 1316389562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP6141) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301015408) |
| Enumeration Date | 2013-07-29 |
| Last Update Date | 2023-04-05 |