| NPI | 1023352952 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: UT 4860874-3102) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: UT 4860874-3102) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |