| NPI | 1619149804 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP3355) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 3218) |
| 103T00000X Psychologist (Licence: MN LP3355) | |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2016-11-01 |