| NPI | 1710004163 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN LP1114) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MN 4137) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2007-07-09 |