| NPI | 1609920164 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP1134) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 08691) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2019-04-03 |