| NPI | 1639183825 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN lp2837) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: MN R083276) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-09-25 |