| NPI | 1710328448 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301015182) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: SC 1224) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2015-08-05 |