| NPI | 1578609624 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 3400) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301008525) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-07-08 |