| NPI | 1013584036 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AZ 11148219) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 11148219) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2023-07-10 |