| NPI | 1962804773 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN 6664) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO PSY.0005351) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2021-03-19 |