| NPI | 1710170428 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN LP4678) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IL 071.007318) |
| Enumeration Date | 2007-08-26 |
| Last Update Date | 2021-03-11 |