| NPI | 1588963813 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301016430) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WI 3297-57) |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2015-12-15 |