| NPI | 1861567513 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP4647) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN 4647) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP4647) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2021-01-08 |