| NPI | 1386130193 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361007576) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MI 18-59778) |
| Enumeration Date | 2018-07-04 |
| Last Update Date | 2024-05-24 |