| NPI | 1942608856 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301016846) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301015646) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2017-03-16 |