| NPI | 1982074225 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MS 601060) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP6279) |
| 103T00000X Psychologist (Licence: TN 3707) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI L957315) | |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2022-02-12 |