| NPI | 1356678320 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301015276) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 6301015276) |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2016-04-20 |