| NPI | 1902362346 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6362008876) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MI RBT-18-66046) |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2020-07-01 |