NPI | 1992298087 |
---|---|
Former Name | NICOLE MARIE OUTMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6351004491) |
Additional Taxonomies | 106S00000X Behavior Technician |
Enumeration Date | 2018-06-13 |
Last Update Date | 2022-11-22 |