| NPI | 1871670646 |
|---|---|
| Former Name | LAURA MICHELLE FEDOTOTSZKIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 8622) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301012594) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-04-24 |