| NPI | 1013154079 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZA2600X Specialist/Technologist, Other, Art, Medical (Licence: NY 000704) |
| Additional Taxonomies | 283Q00000X Psychiatric Hospital (Licence: NY 000704) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2018-03-17 |