| NPI | 1821128711 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP1530) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MN 0689) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2007-07-08 |