| NPI | 1720474067 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6362009252) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MI RBT-15-06950) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2022-03-09 |