| NPI | 1710041850 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP1432) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA TE61047907) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2020-07-27 |