| NPI | 1710170782 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN 5966) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA 60161843) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2016-05-20 |