| NPI | 1649471954 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301003905) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MI 6301003905) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2007-07-08 |