| NPI | 1003891714 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: WA MD60765294) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: HI 12946) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: WA MD60765294) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2019-01-26 |