| NPI | 1790931251 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 6301013657) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301014282) |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2009-10-07 |