NPI | 1760531966 |
---|---|
Other Name | MICKI MARILYN KLOSS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: AZ LMFT0157) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: AZ 2948116) |
Enumeration Date | 2007-01-09 |
Last Update Date | 2007-07-08 |