| NPI | 1891808424 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN LP1485) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MN LP1485) |
| 103TH0100X Psychologist Health Service (Licence: MN LP1485) | |
| 103T00000X Psychologist (Licence: MN LP1485) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2008-12-11 |