| NPI | 1760765549 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301016753) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI G630108139199) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2018-03-17 |