| NPI | 1770990392 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301017820) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA 33042) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2022-10-09 |