| NPI | 1619541174 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6362008863) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 6362008863) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2021-07-06 |