| NPI | 1962696633 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301010923) |
| Additional Taxonomies | 103TR0400X Psychologist Rehabilitation (Licence: MI 6301010923) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2007-09-13 |