| NPI | 1639723620 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6362009599) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MI RBT-19-93666) |
| Enumeration Date | 2019-07-28 |
| Last Update Date | 2022-08-29 |