| NPI | 1558648774 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 5975) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP5975) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2025-05-16 |