| NPI | 1538712807 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN cc04834) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2025-02-19 |