| NPI | 1396155628 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6361001765) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 6301016366) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2020-04-30 |