| NPI | 1053736827 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MO 2015027344) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2023-12-05 |