| NPI | 1477650661 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301007134) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 6301007134) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 6301007134) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |