| NPI | 1952705170 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN LP5877) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 6301014810) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2019-06-24 |