| NPI | 1558662148 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP5830)  | 
| Additional Taxonomies | 103T00000X Psychologist (Licence: ND 475)  | 
| Enumeration Date | 2010-11-12 | 
| Last Update Date | 2016-07-11 |