| NPI | 1467049163 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6352001075) | 
| Additional Taxonomies | 106S00000X Behavior Technician | 
| Enumeration Date | 2020-12-29 | 
| Last Update Date | 2025-08-11 |