| NPI | 1568457927 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN MN3625) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN MN3625) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP3625) | |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2021-10-15 |