| NPI | 1811057185 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301005330) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301005330) |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2007-07-08 |