| NPI | 1497028468 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301012143) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 24811) |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2014-03-19 |