| NPI | 1639793011 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361007614) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6362009213) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2023-10-12 |