| NPI | 1508274572 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301015238) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301015238) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2022-01-04 |