| NPI | 1912905704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: MI 6301012547) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301012547) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2013-07-29 |