| NPI | 1558469353 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP 5415) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP 5415) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-06-19 |