| NPI | 1891912960 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 6502) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 6502) |
| 103TC0700X Psychologist, Clinical (Licence: MN 4745) | |
| 103TF0200X Psychologist, Forensic (Licence: MN 4745) | |
| 103TF0200X Psychologist, Forensic (Licence: OH 6502) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2008-11-20 |