| NPI | 1396722013 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN LP4604) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP4604) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2020-08-24 |