| NPI | 1962770685 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN 5425) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WI 2918-57) |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2019-04-22 |